Sameer Puri D.D.S. One of the most underutilized uses of the CEREC system is its ability to do out of the box type restorations. One such restoration that works well is fabricating Maryland bridges. Now I know many of you think that Maryland bridges don't work- that they debond from the teeth. Nothing could be further from the truth if you do it properly.
First of all, I like to use this restoration more as a transitional type restoration instead of a permanent solution. Typically my treatment of choice would be dental implants to replace a lateral incisor for example. But what to do while that implant is healing and the patient has a space? This is where the Maryland bridge comes in play. There are several different techniques to design these restorations. The ones that you see below were designed in bridge mode. You can also mill these out of several different materials. I think emax is appropriate or if you don't want to use emax for whatever reason, a Cad Temp or Telio Cad block would also work well. As you can see, one of the challenges is that the sprue is on the wing of the bridge. The solution to the sprue placement is to only design these with one wing. Research has shown that with one wing, there is a significant decrease in debonds because you have only one wing bonded and the other side is free floating which results in less stress as the teeth move. By bonding to only one wing, you also have a place to put the sprue and done properly, this can be a restoration that has the potential to last the patient well until the implant or other more permanent solution is ready to be placed. Some of you may be thinking, why not just use this as a permanent solution? Frankly, I think this could potentially be a permanent solution for the patient in the right indication. But whether permanent or temporary, this is a great tool to have in your restorative tool belt.
